ABPI Code of Practice

The ABPI workshops give you a firm understanding of key Code
principles and how these apply in everyday situations.
Unlock strategic and creative insights to give you a fresh
approach to developing winning marketing campaigns.

Digital

Digital showcase 2011: The future of digital marketing

Please note: this report contains exclusive content for PM Society members. PM Society members can view this content by logging into the website. If you are not a PM Society member, you can join online here.

Do you know how to maximise your success with digital communications? Following the success of the PM Society Digital Media Awards in 2009 and 2010, this meeting set out to look at the future of digital marketing. Chaired by leading expert in digital media Alex Butler, the meeting drew on the experience of two eminent keynote speakers, and also showcased three award-winning digital case studies. A panel of pharmaceutical industry digital experts was on hand to provide insight into what made these initiatives stand out at the 2010 Digital Media Awards.

A fundamental change

Working as marketing communications manager for EMEA at Janssen, meeting chairman Alex Butler's aim is to introduce new and more integrated models of marketing and communications. Setting out the agenda for the meeting, Alex noted that digital technology is moving at such a rate that it is almost impossible to keep up, yet there have not been many corresponding innovations in the pharmaceutical sector when it comes to the fundamental changes required in marketing and communications.

The internet – interesting only to geeks in the 1990s - is now ubiquitous. In Alex's view, it is impossible to underestimate the impact the internet has had on society and the way society works. The internet is about connecting people together, and in that way changing the world. For the first time in history consumption of television is decreasing, yet Wikipedia has grown dramatically. Wikipedia came about by people going online and contributing and sharing information so they can then gather more information. This connection that people are making with each other by forming groups is at the heart of digital communications. At the moment, Pharma and healthcare are both a long way from utilising this effectively, yet digital communication could fundamentally revolutionise the way we do clinical trials, undertake research, and even make diagnoses.

Alex believes there is no such thing as digital marketing, it is just marketing. But marketing itself is fundamentally changing as companies move away from just the consumption of messages. The same is true of social media, it is just media. There is nothing on the internet now (certainly not of any value) that is not socialised in some way, even the mobile phone. People expect the information they want at the time and place they want it via the device they happen to be using. And while a lot is talked in the pharmaceutical industry about mobile phone apps, many companies do not even have websites that can be accessed via a mobile handset. Clearly a lot of work is needed and this meeting begins with three case studies showing just how it can be done.

Presenting the first case study, David Hunt (Digital Director, Creative Lynx) emphasised that browser-based content now accounts for only around a quarter of all internet traffic. Fewer and fewer people surf the web and instead the internet is becoming a channel of communication, with the bulk of the usage across apps, emails and ftp. Surveys show that approximately half of us now get our news from a smart phone device. By 2013, half of all phones will be smart phones, and sales of smart phones will exceed those of the pc. It is also predicted that by 2015 we will access the internet more through a smart phone than through a pc. So the mobile phone is becoming intrinsic to everybody's lives, and the rationale behind this particular project was that this includes dermatologists.

The PASI score
Sameer Mistry (Medical Lead, Immunology, Neuroscience and Pain, Janssen) went on to outline that psoriasis is a severe chronic disabling dermatological condition that is seriously underestimated and undertreated. There are various ways to measure the severity of psoriasis, based on how much of the body is affected, the most widely recognised method being the PASI score (Psoriasis Area and Severity Index). This is used in clinical trials, and by NICE to determine who gets which types of treatment. However it is quite complicated, requiring mathematical calculation. It takes expertise and practice to use it and for this reason it is not widely utilised. The Janssen brand team realised that if dermatologists calculated the PASI more often to assess how severely affected many of their patients were, they would perhaps access the right treatment for many more patients. So together Janssen and Creative Lynx set about creating a tool to make it easier to measure the PASI score, something which lends itself to an app for smart phone or iPad.

Around 30 million mobile phone apps are downloaded everyday from the app Store. When it comes to apps, however, people are generally impatient and user experience and value is key. Unless you deliver something that has a real benefit that can be used immediately, it will not work because people will move on to something else. An app to calculate the PASI score would provide real benefit to dermatologists, and to their patients.
How the app works
When users click on the app there are two different versions, one for health professionals and one for the patient. The health professional PASI calculator first asks the user to select a body area (head and neck, arms, trunk, legs), then select the amount of coverage, the extent of redness, the infiltration, and thickness. To calculate the PASI score they must complete the process for all four body areas. The patient version has a severity calculator which is a simplified version of the PASI calculator. It also includes an impact questionnaire and is closely allied with the Psoriasis 360 social media campaign. Both patient and health professional versions are intuitive and simple to use.

The latest issue is a complete psoriasis app with added functionality. This includes the PASI calculator, and also a body surface calculator, a news feed, and, at the request of dermatologists, the DLQI calculator (the Dermatology Life Quality Index). The DLQI is a widely used quality of life assessment tool, also used by many payers to determine access to drugs. It was not included in the initial app due to protracted discussions with the University of Cardiff who own the patent. However, eventually they agreed that it could be included in the combined app alongside the PASI. The latest app also includes a results centre, allowing patients to assess their results over time. This report can be emailed to the dermatologist.

Launched at last year's EADV meeting (European Academy of Dermatology and Venereology) just after the emergence of the iPad, the app is available in five different languages across 53 countries, and downloads currently total 12,000, with approximately 50 downloads per day. The average time spent on the app is over 10 minutes.

David Hunt, Digital Director at Creative Lynx, has been with the company for ten years, working in healthcare digital communications, where his role is to ensure that the technology meets the business needs. Sameer Mistry is Medical Lead for Immunology, Neuroscience and Pain at Janssen. Within that role has a strong interest in the use of technology, apps, and social media in the healthcare context.

Discussion

On the panel to discuss what made the initiatives showcased at the meeting stand out at the 2010 Digital Media Awards were Hilary Smith from Sanofi Aventis, brand manager for nine products and responsible for their pricing strategies and their promotional mix, and Irina Osovskaya from Janssen who has been working in digital media for nine years. Irina Osovskaya stressed that core of the success of this project was that case research into understanding the need was done thoroughly first, and came before the technology – this is not always the case.

For Hilary Smith this app stood head and shoulders above the other work assessed in award category. She was impressed how it made something that is complex very simple and appealing to do. Conversion rates and return on investment are important and clearly this app drives patients back into clinic. It is also important that it is integrated with the Psoriasis 360 campaign. Presence at European meetings will also drive sales. It is a key tool in owning the space in psoriasis (already quite a crowded market) and becoming a trusted partner.

Asked about different country regulations and translation into other languages, David Hunt explained that sister company Digital Lynx undertook the translations and also handled local compliance. Roll out across the different languages was fairly rapid. iTunes automatically recognises which country someone is accessing from and downloads the most appropriate version (when apps are submitted to the apps Store you can choose in which markets it can be available).

Alex Butler added that the app is part of an integrated campaign to raise awareness of the impact of psoriasis and then provide the tools to empower patients to take control of their condition. It also it allows the company to have good conversations with target customers. Also available on Facebook and on the website, actual uses of the application are up to 35,000. It is thought that 60?90% of people who use something like this will do something offline as a result, e.g. go back to their doctor.

Asked about whether the PASI calculator is actually a medical device, Sameer Mistry stressed that it was never thought of as such when first developed, but recently it has come to the company's attention that anything used to monitor a disease on a software platform is potentially a device, so this is now being explored. The MHRA remain undecided on this point and guidance is still needed as to when an app such as this becomes a medical device. David Hunt added it is stated clearly on the app that it is not a replacement for medical opinion.

Mark Duckham (Client Services Director at Adventis Health) reiterated that the internet has changed everybody's lives. He was taught that you have to make the client's life easier and, in his view, sometimes the internet geeks can get very technical and frighten the client. Mark therefore tries to make things easy for the client to understand. His mantra is to provide solutions that can work today, not five years down the line.

In this case the client, Hospira, wished to provide haematologists with an online resource to share learnings with their fellow clinicians and exchange views for the benefit of patient care. The client initially wanted a commercial relationship with haematologists and the challenge for Adventis was to persuade the client to back away from this. Hospira have only recently moved into the UK from the US and had not worked with haematologists before so were therefore keen to start building a relationship. Workshops with key opinion leaders showed that KOLs did not want anything heavy-handed and commercial, but rather something that was of real benefit both to them and their patients.
A global web-based portal
The solution was Haemanet.com, a global web-based portal accessed via simple registration supported by an educational grant from Hospira. This allowed the content to be reviewed by medical but not 'approved'. The 'landing page' for Haemanet.com is clear and simple to use. It is also inviting – people will not engage with something unless it is interesting and exciting. Haematologists can download everything from conference highlights to patient leaflets. It also has resources for professional development and is regularly refreshed with user-generated content. It is international in flavour and includes extensive country specific medical links.

Physicians are most interested to see what key opinion leaders are saying, so it was important to establish good relationships with the KOLs and to get a good stock of material from them. Not surprisingly, the more contentious the material, the more people access and engage with it. After congresses in particular there is a spike in use where doctors look to see what they might have missed. So key in maintaining interest is to make the most of the conferences, and also to have regular updates. It is often forgotten that doctors in specialist areas do not have much contact with each other - only when they go to conferences do they interact and learn from each other. Haemanet.com allows them to learn from the key opinion leaders and also to interact with them via the 'Ask the expert' feature.
The hands-off approach
The aim was for Haemanet.com to be a site for haematologists, with a community feel and not interfered with by Hospira. This hands-off approach has been very popular. The client is happy because they have gained credibility with a group where they had little reputation before - they now have more than 580 members, with up to 370 visits per month (very respectable figures among quite a small community of doctors). Dialogue between doctors and the marketing teams has improved in 82 countries and has given the sales reps something that they can refer to when they call on doctors. Promotional costs are minimal.

In terms of maximising the commercial impact it has been left to local affiliates to make the most of the opportunities the portal provides. It is vital to keep KOLs and clinicians engaged and to keep everything fresh, and there are now plans to include eLearning and accredited webinars.

Mark Duckham is Client Services Director at Adventis Health. Based in Beaconsfield, Adventis Health was formed four years ago with the objective of providing both traditional healthcare advertising and medical education, and also to bring digital into the equation. Katherine St Claire-Smith is Digital Account Director at Adventis Health.

Discussion

Alex Butler reiterated that we have moved from a society that thought the internet was about the sharing of information to one that has understood that it is really about connecting people together. He asked Mark Duckham whether this initiative represents the future in terms of a different way of practising medicine. In Mark's view it is too early to say, but it is clearly happening in certain areas, particularly in smaller countries with low resources. The chance for a doctor in an out of the way place to access the leading figure in his field is tremendous and will clearly help him benefit his patients.

Alex Butler noted that latest ASCO meeting (American Society of Clinical Oncology) was the first fully networked medical conference. It was massive on Twitter and represented a democratisation of information - there are a lot of doctors, particularly in oncology, who have just as strong opinions as those paid to give presentations, and they now have the opportunity to be heard.

Katherine St Claire-Smith stressed that Haemanet.com can be as large or as small as the client wants it to be. A number of other companies have approached Adventis interested in being part of Haemanet.com. The European Haematology Association (EHA) has also talked to Adventis about linking up because Haemanet.com is hands-off and non-promotional. As far as Katherine is aware, this is the only site sponsored at this level by a Pharma company. The EHA have their own site and many of the international conferences offer portals but from a different perspective. While the EHA have full conference presentations on their site, Haemanet.com offers short synopses from either a speaker or a delegate. This provides a different perspective and the EHA do not see it as competition.

Asked whether there were any regulatory barriers, Katherine stressed that from the outset Adventis worked with the medical team to build their trust. In the beginning medical wanted to approve every single word, but over time they realised that websites do not work efficiently like that so standard SOPs were put in place so that they would be more distanced from the content.

Hilary Smith complimented Adventis on the neat side steps they made with regard to the pre-recorded videos, by having pre-briefed experts who knew what they could and could not say. In Hilary's view, that is a good mechanism for avoiding live moderation, which is a huge challenge. For the haematologist on night shift who needs information about a particular product off label, there will be an ongoing issue. It may mean having pre-prepared FAQs, but you can never offer a truly round-the-clock medical information service specific to every off label discussion. Hilary believes this is a key challenge.

Asked by Irina Osovskaya about promotion, Katherine stressed that a small percentage of the budget went on journal advertising and banner ads, but resources were concentrated at congresses in Europe and the US. Launch was at the EHA meeting two years ago, and Haemanet.com was then promoted via exhibition stands at US conferences. Doctors have then spread the word to their colleagues.

With regard to regulation, Katherine noted that UK regulations were used as the main yardstick, but European regulations were taken into account. Adventis also took Hospira's advice and used their affiliates to look after promotion in the individual countries.

Case Study Three: Best Integrated Campaign – Velcade

David Hunt of Creative Lynx began with the brand strategy for Velcade: to establish it as a 'backbone' therapy in newly diagnosed multiple myeloma and to develop market share in relapsed myeloma. The key aim of this project was therefore to ensure that information was available to the target audience via whichever channel was most appropriate to them. Developing material is costly so it was important to be able to re-use assets across all channels. The campaign consisted of an eDetail aid developed for tablet use by the sales force, and also hosted online by Doctors.net, an iPhone app covering dosage, a meetings manager for large group presentations and a website.
The materials developedDavid explained the tablet eDetail aid was the core of the campaign. Many Pharma companies are now moving toward tablet pcs or iPads, so it is important to stand out from the crowd with engaging and creative content and design, good insight and a great story. It also has to be quick and simple to use. This eDetail aid follows George's story to put a patient focus on the information and give context and relativity. The content is highly film-based to make it memorable and engaging, and it is also flexible so that the presentation can be as simple or detailed as necessary. The tool also allows the sales rep to set the agenda for the follow-up meeting by storing the meeting history, with a note of the doctor's particular interests. Meetings manager allows slides from the dosing guidelines to be sequenced for the next meeting, so that messages are tailored to the customer's interests, and then run like a PowerPoint presentation. This feature is also useful for group meetings, and for slide shows at exhibitions and congresses.

The online version of eDetail aid was developed with Doctors.net to identify the target audience, and then strategy was aligned to drive the right people to the messages and build on the story already delivered by the field force.

The website is straightforward with up-to-date product information. It was not core to the campaign but supplied supplementary information. The mobile app was used for dosage details, but the results for this are not as good as the psoriasis app discussed above.

A comprehensive training suite was developed to ensure the eDetail aid worked as effectively as possible and this training programme was a finalist in one of the other PM Society award categories. Training comprised a pre-launch video campaign to get people excited about the material, an interactive exercise to show how to use it, role-play cards, a quiz, pocket guides with FAQs and top tips, site maps, key clinical data, and also eCard teasers.

In terms of results, in 2008 Velcade had a 50% market share for first relapse, and this increased in 2009 to more than 75%. Sales were up by 16% following the campaign. In 2008, 144 hospitals ordered Velcade and by 2009 this was up to 190.

David Hunt, Digital Director at Creative Lynx, has been with the company for ten years, working in healthcare digital communications, where his role is to ensure that the technology meets the business needs.

Discussion

Irina Osovskaya stressed that a few years ago the eDetail aid had a novelty factor over the bag full of papers. In the beginning there was a lot of trial and error in making the eDetail aid as useful as possible. In Irina's view, what sets a good one apart is its purposefulness, utilising the technology to enhance communication with the healthcare professional so that it is appropriately tailored to the conversation, but also done very rapidly and in a way that is easy to digest, and supported by the relevant clinical data. Also important is to develop the dialogue over visits and the technology now makes it easier not only to keep track of that communication but also to inform the strategy based on individual feedback.

Hilary Smith agreed, noting that doctors are looking for confidence and professionalism. Any way to add fluidity and rapidity to the detail aid will help will set you apart – whether that is faster boot-up time or fluidity of the navigation. In addition, an integrated approach allows marketing to support the sales team in hitting their sales targets.

As to whether this replaces the customer relationship management database (CRM) as far as Velcade is concerned, David Hunt believes emphatically that it does not. Hilary Smith agreed that the eDetail aid is complementary because it provides a qualitative measure and a steering as to how to improve the quality of the next call by concentrating on what was favoured by the customer. This would not be achieved just logging calls. Irina Osovskaya agreed that this kind of system will not be used in isolation from CRM. It was pointed out that this approach would be popular with reps if they could populate CRM directly from the eDetail aid. Irina noted that some of the best examples do precisely that and many aspire to complete integration to close the loop, taking the doctor from the eDetail aid to the website or doctors.net. In Irina's view, in reality the technical implementation of closing the loop between all platforms and systems is not straightforward. A committed product manager can close the loop however, but Mark Duckham stressed that technical and organisational implementation is complex with pockets of data held in different parts of a company, each jealously protected and often on different legacy systems.

While Irina was of the view that the right product manager with the right mindset will be able to close that loop, Alex Butler felt it goes far beyond the product manager – the organisation itself has to make a decision that it wants to handle data and speak to its customers in a fundamentally different way. Face to face contact is very powerful but it is expensive, and what is needed, in Alex's view, is an all-round offering integrated in to that exchange. He firmly believes that the power of taking an iPad to a doctor is not to put the same detail aid in front of him that we had 15 years ago, but to be able to link up doctors so they can share their opinions on the data presented. The power will be in the groups put together by technology.

Session II of the meeting focussed on two keynote presentations:

Presentation:
Knowledge is power - supporting patients in the digital space

The internet is the engine that is driving a reformation in healthcare by changing the relationship between doctors and patients. That is the view of Joanne Shaw, Chairman of Datapharm, a provider of medicines information online including the electronic Medicines Compendium (eMC) for health professionals and Medicine Guides, written for patients and the public. Joanne believes that the internet enables patients to take control of their health, to be better informed and to make informed choices about their healthcare. While this is very exciting, it is seen as a threat by some healthcare professionals. It is also a tricky change for pharmaceutical companies to navigate, partly for regulatory reasons, and partly because of an ingrained historical mindset around health professionals being the core customer.

A few years ago NHS Direct undertook a simple but useful analysis of the general public, dividing them into three broad categories: 41% use the telephone only, i.e. are not yet web enabled and probably never will be (a diminishing segment); a rapidly growing group of people (43%) who are multichannel, i.e. they are confident in using mobile, web and phone and switch easily between them (those below the age of 20 probably use them simultaneously); the third group (16%) is generally a poorer, younger group who organise their entire lives via their mobile rather than online and who do not open their post.

The importance of the web as a source of medicines information
As more people become web enabled (75% of households in the UK are connected), the web is rapidly becoming the preferred mode of finding health information. Five years ago people were much less happy to trust the internet as a source of health information but that is now changing rapidly. However, 25% of people looking for health information state that they cannot easily find what they need, meaning that many still turn to the US for information, particularly about medicines. While people are searching for information about medicines and diseases (and to self-diagnose), and are beginning to interact with each other around health, very few are able to undertake useful transactions on the web (e.g. book appointments with doctors, order repeat prescriptions, get test results, etc). This differs from banking, for example, where you can undertake most transactions online.

Data from an online Datapharm survey embedded in a range of voluntary organisation sites (Macmillan cancer, the MS Society etc) and also on Medicine Guides showed that, for those responding, the web is becoming more important than traditional sources, such as the pharmacist, though doctors are still important. Fewer people are using social networks in relation to medicines and health yet. When they do use the web in a more interactive way they want to talk about their health experience, ask questions of other patients and seek help from people who have had similar experiences.
Forums: risk or benefit?
Discussion forums around medicines are generally regarded as high risk because of potentially unbalanced views. Datapharm looked at four medicines: Januvia for diabetes mellitus, Singulair for asthma, Requip in Parkinson's Disease, and Valtrex for Herpes infection, to ascertain whether online comments regarding these medicines were positive and reasonable, and what issues people discussed. Encouragingly, and perhaps surprisingly, comments are largely careful, thoughtful and balanced (admittedly after moderation). There are many positive posts and many negative but not many are wildly inaccurate. Overwhelmingly people are interested in efficacy and side effects, and about the disease, as well as practical issues such as dosage. So in fact these forums are adding value for patients.
NHS Direct and mobile apps
For a couple of years now, NHS Direct (of which Joanne is Chair) have provided a suite of online health and symptom checkers. These provide an interactive personalised experience resulting in an endpoint. This might be self-care advice, or an invitation to have a nurse call you back, or advice to see a health professional immediately. It is now the case that more people access NHS Direct online than via the telephone - NHS Direct receives around 4.5 million telephone calls per year whereas there are about 8 million uses of the online symptom checker per year.

Joanne went on to note that the use of mobile access is growing rapidly, much faster that internet adoption ever was. Thousands of health apps are now available via the iStore (including the Merck Manual, Davis's Drug Guide, etc), many of which are free. NHS Direct launched its health and symptom checker as an Android and iPhone app at the end of May 2011, with 220,000 downloads since then, so clearly there is a huge appetite for this kind of tool.

Patient information leaflets
The main source of information for patients about medicines is the patient information leaflet. Many of these are very good now that there is a user testing requirement, but because they are one-size-fits-all they cannot cover whether a medicine will suit a particular individual, for example. And because they are product specific they cannot cover the range of medicines that can be used to treat a particular condition. In addition, surveys show that there is subtle but distinct difference between the information required by carers and what patients want. Both are interested in dosage for example, but carers are particularly interested in how to administer medicines effectively, while patients want information that helps them make well-informed decisions about treatment choices in managing their own condition.

Confidentiality
Joanne went on to discuss MediGuard UK, and online resource which has 80,000 users in the UK. In return for registration information, users get back an analysis of the interactions between the various medicines they are taking, receive regular updates relating to their medication, and feedback on aggregated user experiences. The success of MediGuard demonstrates people's willingness to provide detailed personal information in the digital space, as long as there is some value back for them.

The NHS get very anxious about patients' views on confidentiality and what they are prepared to share, but Joanne believes that MediGuard tends to suggest that people are prepared to trust the people holding the information in order to get value back for themselves. A recent Bupa survey of 1000 patients in 12 countries (Health Pulse 2010) showed that people would like to be able to do much more online in relation to their health, e.g. view their medical record and receive test results (via a secure site), book doctors appointments, email their doctor, order repeat prescriptions, etc. Access to this sort of transaction is currently very limited.

Taking control
With regard to impact on health and behaviour, it seems increasingly clear that the internet is empowering people to take control of their health and is fundamentally altering the nature of the relationship between patient and health professional. The information patients take from the internet is changing the way the doctor manages the patient's condition and the treatment prescribe. In Joanne's view, the internet is empowering people to change the way their health is managed.

Joanne Shaw is Chairman of Datapharm Communications, a leading provider of digital medicines information to the NHS. She is also Chair of NHS Direct and sits on a number of other boards in healthcare and elsewhere.

Discussion

In response to a question from Alex Butler about the number of downloads of the NHS Direct symptom checker app, Joanne Shaw stressed that a large proportion of people using the app will ultimately want to speak to a nurse. The danger is that eventually the knock-on demand on the telephone service will increase as a result of the app so the two need to be managed together. However NHS Direct believe that multichannel advice is important because ultimately it frees up face-to-face and bricks-and-mortar resources, allowing them to be reconfigured.

With regard to how industry engages with Datapharm and NHS Choices, Joanne stressed that Datapharm was set up by the pharmaceutical industry and has 200 pharmaceutical company members and as such is a strategic partner of the industry. It provides a bridge between individual companies and the NHS and medicines users, by aggregating information at a central source. Member companies supply Datapharm with SPCs and patient information leaflets which are then provided to NHS Choices. Increasingly Datapharm is authoring Medicines Guides, which are consistently written across all medicines making it easier to compare medicines than via the patient information leaflets, which vary in format. In addition, Datapharm are now inviting companies to link other tools around managing conditions to the Medicine Guides resource.

Asked if there is enough information online for UK patients, Joanne stressed that there is room for much more health information online. She believes in a 'plural' health economy and has no problem with duplication. A wide range if information resources is required because individuals differ as to the kinds of information that works for them.

As to provision of patient information on the value and cost of medicines and issues around the rationing of their care (so the informed debate can focus not just on the individual patient but also on the needs of the population), Joanne stated that Datapharm are working with the NHS Information Centre to make available information about prescribing and dispensing on a local and real-time basis in a way that is valuable to both patients and companies.

With regard to the demise of Google Health, Joanne felt that in a dynamic information environment some things will succeed and others will not, and that is to be expected. She believes that a proportion of the UK public are ready to take on the administration of their own health data, and made the analogy with retail banking. Between 2000 and 2010 the number of people signed up for telephone banking increased from 4.6 million to 46 million, and the number signed up for web-based accounts increased from about 1 million to 40 million. There are some parallels between managing your own money and managing your health record. Not everybody will want to do it, and not everybody should have to, but Joanne is convinced there is a strong appetite for it.

Alex Butler asked how doctors feel about patients emailing and texting them. Joanne stressed that doctors think they will be constantly bombarded by their patients, but it is actually more about how confident they are about making shared decisions with patients. Many doctors are good at this, but others find it threatening. Doctors who are enabling emails from patients report that they are having a much better experience with their patients.

[membersonly]Presentation:
It's not a phone - a future of mobile marketing

'Everything should be made as simple as possible, but not simpler'. Here Einstein has neatly and presciently encapsulated why mobile technology has been so successful, according to Mark Blayney Stuart (Head of Research, Chartered Institute of Marketing). The reason is that a mobile phone is not a phone, but a very powerful computer that just happens to make phone calls. The mobile phone is already an alarm clock, a calendar, a diary, a map, a photo album, and while it does not replace all these things, it is starting to supersede them. Already more than 50% of us are never more than three feet away from our phone. In India more people have access to a mobile phone than to proper sanitation. Morgan Stanley expects mobile internet usage to overtake desktop usage by 2015.

Why has his happened? Because the phone is always switched on, unlike the television which we switch on when we want it, and then turn off again, and even the computer, which we open to get what we want and then close again. Over a very short period of time, and almost without us noticing, the mobile phone has changed our relationship with information. Fifteen years ago, to find information we had to go to the library and look through a number of books. Ten years ago we had to click a button on our computer. Now we reach in our pocket for our phone and in two minutes we have the information we need. The mobile phone is no longer just a device, but has become part of our lives.

New opportunities
The mobile provides opportunities for new ways of reaching people because it is location sensitive. Burger King has an app to direct you to their nearest branch wherever you are located, and also allows you to order over the phone so that your food can be waiting for you when you arrive. In a few years' time, apps like this will not be so innovative, but at the moment they work because they are new and people respond to them.

The mobile phone is also time sensitive, meaning we can give new life to the idea of coupons. Dynamic couponing has not yet been used to its full potential. It means that commercial marketers can run a campaign on the day, and campaign messages can be adjusted to suit external or political background events, for example in hot weather you can promote ice cream, on a wet day you can promote hot soup. In the pharmaceutical sphere this means you can respond to events in the news. It is also very useful for small companies or entrepreneurs because the technology is easy to use, widely available and inexpensive.

However apps are only successful if they actually answer a specific customer need or want. Mark cited the example of the Ikea app which allows you to look through their catalogue on the phone, select the sofa you like and drop it into a photo that you have taken of your living room so you can see how it looks in situ. This answers the customer need: even though I like the sofa in the showroom how will it look in the living room? The app is therefore building the brand because when we do buy a sofa we are more likely to go to Ikea.

Choices and recommendations
As marketers we are used to offering choices. In fact we are now deluged with choices, but does that help or does it make things harder? Much more credible and convincing than a list of choices is the aggregated data of people's recommendations. Instead of choice, we feel safer with a recommendation from real people. All of us now do this instinctively, when we look at Trip Advisor for holidays, for example. The word of a stranger can be much more effective than the commercial message, which we tend to zone out now.

The way we use social media is also changing. We place it more and more at the heart of what we do, and we listen to recommendations and act on them. If someone recommends something on Facebook and six people agree, we are more likely to go for it. So when doing promotions if you get your strategy right people will start 'sneezing' on social media - one person 'sneezes' something, so others come and look at the same content and then 'sneeze' it to their circle of friends and followers.

When people are deluged with choices, trying to make your offering stand out from your competitors needs effective incentivisation. You might offer a 75% discount, and the time and location sensitivity of the phone means that if you have stock to shift by the end of the week, you can run a campaign at the last minute and target it to a particular group or location. The caveat is that consumer protection regulations state that any commercial activity online or via the phone has to make its commercial origins clear.

A changing relationship
Globally, more people now have mobile phones than bank accounts. The number of people with smartphones rose from 9% to 24% in just one year. In the developed world our relationship with the phone is changing. For marketing this means that mobile is not so much one of a number of channels, but THE place where people want to access their information. Also, within three years we should have sufficient bandwidth so that mobile internet becomes as fast as internet on the computer. At that point people will not bother switching on the computer, but use the phone for everything. A key insight relevant for all companies is that not only do you need to ensure that your website works on mobiles but also that it is optimised for mobile access, so there are design implications.

Mark Blayney Stuart is of the view that we will reach the tipping point where we start to use mobile phones instead of cash, something already very popular in Japan and South Korea. At the moment we are all wary as to whether it is safe, but rationally it is no less safe than using a credit card.

The way to more information
QR tags allow you to scan a bar code which leads you a site with more information. These tags have been very effective in zoos, art galleries and museums, but if we are in a museum we already have an appetite to learn something new, so we will make the effort to click and download. In our daily lives, generally we cannot be bothered. QR tags can attract attention in very creative ways, for example on a cake, or on a person, but to work effectively they need to be incentivised and individuals need to know that there is genuine content at the end. In the pharmaceutical and medical field this provides many opportunities, because a QR tag is a good way of creating a tailored route to get to relevant knowledge, for example in the doctor's surgery, or in a particular communication.

There is an assumption that we like technology. Some of us do, but the vast majority actually do not and the proof of that is how annoyed we get when technology fails to work. What we like is having a problem solved for us. So if the technology makes something easier, or quicker, or more effective, then we will use it. So think about what your company offers the customer that your competitor does not. And then think about how to use an app to make that offering better or easier for the customer. Do not use the technology for the sake of it, or you will not get the ROI.

Privacy issues
With regard to privacy, we have certain assumptions that are not necessarily true. We think when we are online that we are in a private or temporary space, but that is not the case. A commonly expressed concern is that today's teenagers will find that when they apply for a serious job there will be evidence online of their drunken antics. On the other hand, the teenager's response when applying for that job will be so what, because the person interviewing them will also have a private life on Facebook. Mark's view is that there will be a change in business etiquette so that it becomes accepted that everyone is entitled to a private online life.

The impact for marketing is that privacy, like any other commodity, has a price. Big brother is watching us, but if we like what they are offering then we are more willing to share information about ourselves, As Joanne Shaw demonstrated with the MediGuard example. We do not mind a company having our information as long as they are transparent about what they are doing with it and we know that we are getting some benefit from what they offer. The key therefore is to be transparent with the individual and ensure they know what data you have on them and what you are using it for. Anything that could be perceived as intrusive should be positioned as a choice.

B2B marketing
Mark went on to give some specific examples of apps that are beneficial for business-to-business marketing (B2B). Flowtown provides segmentation data such as age, profession, gender, the social networks customers use, when all you have is a customer's name and e-mail address. Trackur helps you spot trends and identify what resonates emotionally with customers by monitoring and aggregating data from social media. Social Mention is a social media search platform that tells you which key phrases are being frequently tweeted, added as status updates on Facebook or searched for on other social networking sites such as LinkedIn. Samepoint is a 'conversation search engine' that similarly identifies what customers are interested in and talking about.

In B2B, if an app includes information then it has value and it is appropriate to sell it. However, because of the free nature of the internet we now expect to be able to turn on the computer and get our news for free so we are irritated if we come up against a paywall, even though rationally it does not make sense. Because the internet has changed our expectations, it can often be best to make an app free to encourage take up. That way you drive the brand and the theory is that you sell more. Mark gave as an example the Guinness Pub Finder, a GPS-enabled app to help you find a pub that serves Guinness.

The future
In Mark's view, the mobile phone can take two different routes take in future. One is the smart device that contains everything you need for your day-to-day life. The advantages of this are obvious but the downsides are the risk of loss, and the problems of running out of memory, or exceeding data usage limitations. The other direction is a dumb device that is cheap, simple, even disposable, but which accesses data stored elsewhere when it is required. This carries no storage or loss issues, but relies on greater bandwidth than is currently available. As bandwidth issues are ironed out, the 'dumb device' model may become popular, with all the individual's user-specific and personal information, favourites and history stored on a separate server.

Mark Blayney Stuart is Head of Research at the Chartered Institute of Marketing, where he publishes regularly. He also speaks across the UK, has written for The Independent and appears on BBC Radio 4.

Discussion

Asked whether it is preferable to develop dedicated apps or platform agnostic versions, Mark Blayney Stuart stressed that it depends on what you are trying to sell and on how your customer wants to be reached. The answer is initially a portfolio approach offering both, and then to research into who your customers are to find out what they prefer and adjust the offering accordingly.

On the subject of the younger generation of people who want everything via mobile, Mark agreed that there is a shift, as Joanne Shaw stated, so that often teenagers will not open their post. The belief that sending important information by post is the most secure way to reach people will not work with that generation. The NHS tends not to send messages via mobile for security reasons, but this will be addressed in the next few years. The perception that mobile is open to hacking and the post is safe is wrong, because in fact the Royal Mail loses vast amounts of mail every year. Mark believes the answer is to research individual needs and wants, to build a dynamic database, and then reach people in the most appropriate way. This will have associated cost savings.

Asked about mobile over iPad, Mark agreed that people will use their mobile on the move but back at home they will use the iPad or computer, just because of the greater screen size. In his view, ultimately the optimal device will be something larger than a phone but smaller than an iPad, or perhaps the size of a mobile phone which then opens up to something more like a notebook.

It was pointed out with regard to QR tags that there has been a debate in the European parliament in relation to 'pull' rather than 'push', so it acceptable to provide information that consumers have to actively pull, but not to push information at consumers. A member of the audience from Vodafone Health Solutions commented that they have been working with what they call 2D bar codes (QR tags) for some time with community health workers so they can then view the electronic patient record. Mark agreed that there are plenty of similar opportunities. Of course it will mean a change in patients' relationships with doctors. Often the doctor offers choice when really the patient wants the doctor to advise what is best. The doctor therefore needs to judge how much information and how much choice is right for the particular patient.

[/membersonly]

Meeting summary

Alex Butler stressed that in looking at the future of digital marketing the meeting talked not about platforms or technology, but about people coming together, and about changing the nature of the way we live our lives. In future, people will expect the physical world to be completely integrated with the digital world, so the idea even of clicking on a QR tag will soon look old-fashioned when people expect everything they touch to have the capacity to hold and transmit information.

This will have a dramatic effect for health. Information about health and medicines has always been there, and a patient 15 years ago wanting to understand more about psoriasis could have gone to the library and found out about it. The point is that access to that information has changed. That is what Pharma needs to get its collective head around. Broadly speaking people want to do good, and to help others constructively. In Pharma we still think that we can control society when in fact society will control itself. Alex does not believe that people 'use' mobile or social media. They actually 'live' it.

We always ask what the future of something is, but it is impossible to say. We could never have predicted even two years ago where we would be now. But already there is the idea of 'community of practice', where people come together to help others, often for simple things. So it is not just a question of connecting people to doctors but connecting them to other people who know more about living with a condition than the doctor does. Social media is not about connecting people who already know each other (that is boring), but connecting people who do not know each other but would want to if they knew they existed. That will be the true power of digital communication. It is Alex Butler's hope that in a year's time Pharma will not be discussing minutiae like Facebook comments but collaborating with stakeholders to improve patient by utilising the whole of society.